Neuropathic Pain (NP)
Neuropathic pain (NP) is a common form of human pain, often poorly responsive to analgesic medications. This chapter discusses the pathophysiology and conventional treatment of common categories of neuropathic pain and reviews the literature on botulinum neurotoxin (BoNT) efficacy in neuropathic pain. The level of efficacy for BoNT treatment in each category is defined according to the published guidelines of the American Academy of Neurology. The data on type A toxin (mostly onabotulinumtoxinA, onaA) indicates efficacy in postherpetic neuralgia and probable efficacy in post-traumatic neuralgia, and painful diabetic neuropathy. Retrospective studies and anecdotal observations suggest efficacy in residual limb pain of amputees, complex regional pain syndrome, and chemotherapy-induced allodynia. Controlled studies are necessary to assess the efficacy of BoNTs in these conditions. Much remains to be learned about the most effective dosage and technique of injection, optimum dilutions, and differences among BoNTs in the treatment of neuropathic pain.
KeywordsBotulinum toxin Botulinum neurotoxin Neuropathic pain Pain Allodynia Postherpetic neuralgia Post-traumatic neuralgia Diabetic neuropathy Complex regional pain syndrome Phantom pain Residual pain
Patient 3-1(postherpetic neuralgia). Grid-like injection of the right postauricular region (MOV 16826 kb)
Patient 3-1. Interview with the patient with PHN, 2 years after treatment with onaA (MOV 130718 kb)
Patient 3-2. Post-traumatic neuralgia: interview after two treatments (MOV 78315 kb)
Patient 3-2. Post-traumatic neuralgia: subcutaneous injection of onaA into the pain area (third injection) (MOV 65903 kb)
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